i might say the majority of americans strongly support. and i'll stand with others as we make our case by keeping it in the reform plan. as part of this process, i was proud to join senator brown and a core group of more than 20 other senators in introducing a resolution affirmation support of a public option. a public option would give more consumers choices to select affordable and quality health insurance plans while helping to drive down overall medical costs for real competition in the health insurance market. and to further enhance the advantages of a competitive market, i've introduced health insurance industry antitrust enforcement act of 2009. this would repeal the antitrust exemption for health insurance and medical malpractice insurance providers. if we close this loophole in our antitrust laws, a loophole that's long overdue to being

closed, i will offer my legislation as an amendment to the bill to do that. antitrust enforcement promotes competition. it helps to lower prices and expand consumer choice. another factor that contributes to the rising medical costs that all americans face is fraud within the health insurance plan. the scale of health care fraud in our system today is staggering. studies estimate that between 3% and 10% of all our health spending, both public and private, is wasted through health care fraud. that's somewhere between between $60 billion and and $220 billion each year, money that we should have for health care not going in the pockets of crooks, and to help bring this waste out of our system, senator kaufman and i and others have proposed the health care fraud enforcement act to toughen sentences for those who commit health care fraud, to strengthen support for prevention, investigation, and

prosecution of health care fraud, sharpen the legal tools we need to go after this fraud. it would prevent wasted spending. it would hold accountable those who do the stealing. experience shows the antifraud efforts give taxpayers a superb return on investment. the payback between $6 and $14 for every dollar we spend on enforcement. i'm pleased the majority leader included provisions in the bill to address the issue of health care fraud and i'll work with senator kaufman and others to strengthen that bill. madam president, vermont has helped pave the way for some of the reforms including this bill, and now for the third year in a row, vermont has been ranked as the healthiest state in the nation. vermont is one of the earliest leaders in expanding the state medicaid program under reforms led by former governor howard dean and others, but yet under the current form of this bill, vermont would not share the

enhanced federal match to be offered to other states. that would amount to regressive policy with adverse political ramifications for vermont is a leader in expanding access to health care. i was heartened in my conversation this morning with the majority leader when he tells me that we will try to correct that problem. but we can't correct any of these problems until we debate the bill. let's not hide under our desks because we're afraid to stand up and vote and debate. the people of vermont have given me the honor of representing them in the senate for 35 years. i have joined in many debates that were contentious yet ultimately productive. i have been on the winning side, i have been on the loosing side. but as we leap through the pages of history, we can read many times in the senate has shown its remarkable ability to rise up to reflect the conscience of

the nation. those moments were forged in the crucible of national need, against the anvil of the tempered will of the senate's membership. this senate could do that again. my dear friend, senator ted kennedy, said it so well in a letter about the health reform imperative, that president obama read to a joint meeting of congress. this is where senator kennedy reminded us what we face above all is a moral issue, that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country. this is such a time. it's my hope and belief the senate that i love will once again rise to the occasion. madam president, i yield the floor.

a senator: madam president? the presiding officer: the senator from colorado. mr. bennet: i would first like to thank the senator from vermont for his excellent remarks in what is, after all, just a vote to get us started on the debate on health care, a procedural vote to allow us to be able to amend and improve the bill in the coming weeks. madam president, virtually every single member of this body in the united states senate is a member of the baby boom generation. as in my view a generation of americans, i was born in the last year of that generation, given more opportunity than any generation of people in the history of this planet because our grandparents and our parents were willing to make hard choices, understanding that part of our national creed, part of our legacy is assuring that we're expanding opportunity for those that come after us. we are having this health care debate at a moment in our

country's history beset by incredible economic difficulties. this is the worst recession since the great depression. but we now know that even during the period of economic growth before our economy fell into this terrible recession, that powg families were struggling. during the last period of economic growth, median family income in the united states actually declined. as far as i know, it's the first period of recovery in the history of the united states when median family income actually went down, and that was at the same time that the cost of health insurance was soaring in my state by 97%. the cost of higher education in my state going up by 50%. we're saying to american families you live in an economy with incredible weakness, where the growth is actually surging ahead of a mountain of debt, but you're not getting ahead. just this week, just this week,

we learned that in the great state of california, they're increasing the tuition for their universities by 30%. the university of california, the california system has been the envy of the world for decades, and now it's being put out of the reach of working families. so we have much to do here, much to do to make sure we honor the legacy of our parents and grandparents. we honor the legacy of the greatest generation, this generation, the baby boom generation to ensure that we leave behind us not diminished opportunity but more opportunity for our kids and our grandkids. there's much we need to do to make sure we have a health care system that works not just for a few people but for everyone. an education system that works not just for a few kids but for everyone, and that we have an economy here in the united states that values the contribution that everybody can make.

my sense in this health care debate is that the people of my state and i know the people around the country are deeply dissatisfied with business as usual. they hate the current system. they know it's not working for them and their families. they know they're not able to make the choices that they need to make to be able to have the kind of stability for their families so they can get ahead economically, but on the other hand they are deeply worried about our capacity to make it worse. it's hard to blame people when you hear the special interest rhetoric coming out of washington, d.c., or when you turn on your cable television set at night and watch what people have to say, you can understand why people are concerned that we have the capacity to make it worse. that's why i'm so pleased about the piece of legislation that the majority leader has brought before us. we have never been closer to reforming our health care system, madam president, so we can address runaway health care

costs, enact insurance reform, construct stability and predictability in health care for families and small business. senate legislation before us is that promising new way forward. coloradoans as i said have not been shy at all about letting me know about their views of the current system or what their concerns are about what we might do. like people across the country, they know the current system doesn't work for them, but they are worried, as i said a minute ago, that we're going to make it even worse. this bill, this bill represents a substantial improvement over business as usual. i congratulate the majority leader for listening to not just a small group of people, but to people across the aisle, to people all across the country in crafting this piece of legislation. first of all, the most important principle of this bill is that it's paid for. we already had about $5 trillion

of debt when the last president became president, and we're now at $12 trillion. it's been an unbelievable spike since 2000 and today. we have put an enormous burden, and as the father of three young girls, i feel this very personally and very keenly, an enormous burden on our kids and our grandkids. our debt is now $12 trillion. our entire gross domestic product, our entire economy is is $14 trillion. our deficit is $1.4 trillion. 12% of our gross domestic product. that is utterly unsustainable, and what we know is that the biggest driver of our median term deficit are our rising medicare and medicaid costs. the biggest driver of those are our rising health care costs. this bill, unlike medicare part d, a very worthy program passed

during the last administration, this bill is paid for. that drug program for seniors was not paid for. instead of paying for it, instead of making hard choices, what we said to our kids and our grandkids was you pay the bill. by the way, that's what we've said about tax cuts, that's what we have said about the wars in afghanistan and iraq, and we have got to put an end to this. this bill at least starts to head us in the right direction. it doesn't fix our fiscal crisis, but it is an important step forward. as i mentioned a few minutes ago, for working families, the current system has been a complete disaster as their income has remained flat or gone down, their health care premiums have gone up by 7%, and even though there is a lot of conflict out there about what the way forward should be, about what specific policy choice here versus a specific policy choice there, i can tell you one thing everybody can agree on in my state is that their health care has not improved by 97% over the

last ten years. they're paying more and they are getting less. small businesses are getting crippled by the system that we have today. they pay 18% more than large businesses to cover their employees just because they're small. and sometimes people say to me, well, michael, don't you know that's because the pool of employees is smaller, it's harder to spread the risk, and i say i understand that, but as a businessperson, from a business perspective, that is ridiculous. the idea that a small business person trying to execute their businessman, trying to execute their vision and grow their business is going to spend 18% more for something and not get 18% more productivity out of it or not get 18% in this case better health care coverage out of it. in fact, the reverse is true -- is ridiculous. and by the way, one of the things that's really interesting to me about this debate over a public option is that people don't seem to understand what's actually happening today before our eyes as the costs of

insurance are going up every year, fewer and fewer people are able to get insurance through their employer. fewer and fewer employers are able to offer insurance to their employees, which is heart breaking for many of our small business owners because these are family businesses that for years have provided health insurance to their employees. they view it as part of their pact with their employees to help them get ahead, but they can't do it so they are dropping them from the roll. and where are these folks ending up that are now uninsured? well, two places. medicaid, if they're poor enough, or in the emergency room getting covered with uncompensated care that we, the taxpayers, are paying for. we have a public option. it's just -- it's just the least intentional and most expensive public option you can imagine. so we need to understand when we're talking about the changes that we're talking about here, we need to understand what's really going on in the daily lives of people all across our

country. the figures that we have got from the congressional budget office show that this bill will reduce the deficit not add to it, will put our deficits over the first ten years by by $130 billion, over the next ten years by $650 billion. that's $780 billion. you know, one thing we know about those numbers is they're not going to turn out to be exactly accurate, but here's the good news. the c.b.o. is unable to score the benefit of prevention. they are unable to score the benefit of wellness. they are unable to score a focus on primary care instead of emergency room care, and there's a good reason for that. that comes down to execution. how well is the program implemented? and those of us that are proponents of reform carry a very heavy burden to make sure that the execution is good and that we carry this through, but the good news is if we do a good job, we'll save money. i want to say a word about medicare just because there has been a lot of discussion from people that are opposed to

reform that are saying we're cutting medicare. they're saying we're hurting seniors, but what they won't tell you is the worst possible scenario is not taking action now on critical medicare reform. as i said earlier and i have said in many speeches, our medicare program on its current path is headed for a fiscal crisis. policy experts on both sides of the aisle said we need to stop pwaeugs payments on every procedure and every test. instead we should look at successful models like our own rock me mountain health system and mayo health clinic. we know they have better outcomes not just for seniors but everyone. this bill builds on everyone locally. that means protecting the benefits for every senior and for years to come. we make sure doctors will not see a 20% cut in their payments. it makes the entire medicare system more affordable and will

save taxpayer dollars. critics say no to reform. they're content with a system that pays by the test. test after test instead of outcomes and patient-centered care. that approach will assure that medicare is bankrupt by 2017. we need to do better than that for seniors. we need to protect medicare. included in this health care reform bill is a version of a bill i introduced based on great work being done at colorado. it's called the medicare -- it's called the medicare transition act. we looked at the $17 billion medicare was spending on hospital readmissions. currently one out of every five patients leaves the hospital and returns within the same month. we looked at places in denver, in grand junction where the readmission rates are 2% compared to the national rate at 20%. what we saw was that they coordinate care. and as people go from place to place, these health care systems track where they go with a

system of electronic medical records, what medications they use, what doctors they see. they focus on patients -- on patients -- when making decisions. so when we talk about these delivery systems being unnecessary, tell that to the 12 million medicare seniors who got readmitted to the hospital within the very first month they were let out of the hospital. we owe so much more to these seniors, and we owe a lot more to the american people. health care reform must stop the rising costs that are bankrupting working families, small businesses and our economy. if you like your coverage, you should be able to keep it. we need to put it in to denials based on preexisting conditions, give people more affordable options including a public option. one thing is khraoerbgs and that is business as usual -- one thing is clear, and that is business as usual cannot be an option. the debate is bigger than politically charged issues. we have to keep our eye on the ball and not get distracted by the same old tired special interest politics that have kept us from reforming our health

care system since harry truman was president. health care reform should not be about changing our laws on abortion. i think the house went astray when it adopted new language with unintended consequences for women. the senate bill makes sure we do not use taxpayer dollars for abortion. that's why i opposed the house stupak language. i'm for insurance reform. i'm for making our small businesses more competitive by reining in skyrocketing health care costs, for reducing premiums for working families, for more consumer choice, including the ability to voluntarily choose a public option. by the way, madam president, one thing i've noticed is that as people start to understand that they're going to be required to have health insurance as part of this plan, what they're saying is i want all the options. i want a private option, a public option, nonprofit option. i want to be in a position to make the best decision for my

family. we're for reform that squeezes wasteful spepbgt so we can reduce -- spending so we can reduce our deficits in the long term. my focus has been on the average coloradoan, our working families and small businesses. there's plenty in the bill for you. the time for talking is over. we should pass this bill. but tonight what we should do is make sure that we allow the senate to debate the bill, to improve the bill. there are things in this bill that i'd like to change. there are things that i want to make better in the coming weeks. but i believe that if we pass this reform, we will have taken a very important step forward to say we are here to honor the legacy of our parents and our grandparents. we are here to say as one generation to the next that we are going to carry that legacy forward and make sure that we are making a hard decision to provide more opportunity for you, not less. this is only one step of that. i mentioned education earlier. i mentioned our economy earlier. my hope is that in this debate, what we can do is begin to learn

how to set the special interests aside for the benefit of the american people. if we can do that, there's not a doubt in my mind that we'll honor our grandparents' legacy. thank you, madam president. i yield the floor. mr. wyden: madam president? the presiding officer: the senator from oregon. mr. wyden: madam president, even though america has the best doctors and the best nurses, our nation spends too much on health care for what it gets. because the problem in american health care will not cure itself, i rise in support of this motion to proceed, beginning the debate about how

to fix american health care. before i lay out the many provisions in majority leader reid's bill that constitute real reform, i want to talk for just a couple of minutes about how the senate can come together, democrats and republicans, to fix american health care. i've had a chance to visit with almost every member of the senate in their office on this issue, to listen to them. and it's very clear to me, madam president, that both democrats and republicans have valid points. i believe my party is absolutely right in saying that you cannot fix american health care unless all americans get good-quality, affordable coverage. if you don't cover everybody

with that kind of coverage, what happens is those who are uninsured shift their bills to the insured folks, who are already getting shellacked, and there's an underemphasis on prevention. so my party is right that to fix this, you've got to have all americans with secure, good-quality, affordable coverage. i think colleagues on the other side of the aisle have valid points as well. they focused on the need for marketplace forces, for choice, for competition. i subscribe to each of those principles as well. now, i think many believe it is some kind of absurd fantasy that before the senate completes its work on this legislation, the senate could actually come together, democrats and republicans. i simply don't share that view.

and, madam president, let me be clear, it is my intent when this bill gets to the floor, i am going to work very closely with majority leader reid and with all our colleagues to finally break through to get beyond some of the polarizeation, almost brawling that we've seen in town hall meetings with folks sat in opposite sections. that's not america, madam president, when we're facing big challenges. and this certainly is such a challenge. i believe fixing the economy and fixing american health care are two sides of the same coin. you can't spend more than 16% of your gross product on american health care, spot your foreign

competition hundreds of millions of dollars a year and have enough money to focus on education and transportation and domestic needs. the reason so many americans don't see their take-home pay-go up is because health care gobbles up all the costs in sight. so this is a big challenge, and certainly a challenge that demands that the united states senate get beyond some of what has been the fighting, near brawling about this subject across the landant on the basis of the conversations that i've had with colleagues, i continue to believe that the senate can break through and produce a bipartisan bill working with senator reid, working with colleagues on both sides of the aisle. now, madam president, in terms of the real reforms that are in

senator reid's bill, i think it starts with the delivery system, the way american health care is essentially offered across the land. the fact is that today's delivery system essentially rewards inefficiency. it's based on volume rather than quality. now, my part of the country, the kaiser plan, the group health plan, we've actually been in the forefront of trying to move away from a system that rewards inefficiency, rewards volume. and what we have shown is it really pays off. people can be healthier and america can do it for less money. senator reid's bill begins to move in the direction of what we have been doing in our part of the country for sometime.

his bill promotes what are called accountable care organizations. there are changes in reimbursement. probably folks on main street aren't familiar with it. it's called bundling. in effect, instead of paying for each specific service, there's essentially one payment, again, to reward trying to deliver care in an integrated fashion. we've been able to have included in the legislation, madam president, incentives to care for folks at home. the majority leader included a version of a bill i authored called the independence at home act that is backed by many colleagues on the other side of the aisle and many democrats as well. you think about the challenges of american health care going forward, we certainly ought to

agree that it makes sense to deliver more good-quality, affordable care at home rather than forcing americans to spend a big chunk of their day fighting through traffic, taking time from work, simply going to a doctor's office. and we have the technologies, we have the trained geriatricians to offer these kinds of services at home. and i highlight the fact that this is real reform. it's in senator reid's bill. and republicans and democrats alike are behind it. the majority leader makes a number of long overdue changes, madam president, in the private health insurance market. in many respects today, madam president, the private health insurance system is simply inhumane. what you have is a system that rewards cherry-picking, where

the private insurance companies take just the healthy people and send the sick people over to government programs more fragile than they are. what we need is a very different system, where the private insurance companies compete on the basis of price, benefit, and quality, and not who is the best at just selecting out the good risks. senator reid's bill does away with the unconscionable practice of preexisting condition exclusions and the practice of rescission, where the insurance companies abruptly drop coverage for the sick and in effect charge that person more simply because they're sick, because they're a woman, because they work in a high-risk job. so these are very constructive insurance reforms. we're going to try to build on those as we go forward in the legislation. but colleagues should make no

mistake about it. the insurance changes in senator reid's bill are very real reform. madam president, i want to focus for a few minutes, though, on what i think is the great promise of this legislation for health care in the future. ever since world war ii, madam president, there has essentially been no market for american health care. back in the days of wage and price controls, we didn't have a way to get good health care to americans, and we simply said we'll put it on the backs of employers. they were patriotic citizens then. they're patriotic citizens now. and they said we'll figure out how to do it. we're going to have to pass on the costs in the form of higher prices for goods and services. that probably made sense back then, madam president. you had people essentially working a job for 20 years, 25

years. they got a gold watch and a dignified retirement. today there's a very different economy. the typical worker, madam president, changes their job 11 times by the time they're 40. they need a different set of health care choices. they need the opportunity to be empowered, to go into the marketplace, to hold insurance companies accountable, and to get more value for their health care dollar. the majority leader in his bill lays the foundation for this kind of system. he establishes a system of what are called health insurance exchanges. they're kind of like a farmer's market. and senator reid has improved this so that these farmers markets, these exchanges, could only let in good-quality plans, and under senator reid's bill, it would be possible to more

easily compare the plans in these exchanges. this is something i have been interested in for years, really going back to the days, madam president, when i was codirector of the oregon great panthers because i think it is simply bizarre that it is possible in the other parts of american life, almost in a costco store or any other big store to compare products, look at alternatives, have some measure of uniformity and not have that in american health care. what senator reid's bill allows is the beginning of that kind of foundation for a marketplace so that health care in 2009, madam president, will be dramatically different than it was, say, 60 years ago in 1949 when i was born. i don't see anybody outside the capitol driving a car from 149, but much of american health care still resembles the middle of

the last century, and senator reid through his legislation lays the foundation for modernizing it. now, i would like to see more people in the marketplace in the exchanges more quickly. under the estimates that we have been given, only about 10% of our population would be able to enjoy the fruits of real choice and real competition. and real choice and real competition in that marketplace, madam president, is the path to holding premiums down. my goal in the years ahead is to allow every consumer, every consumer, for example, in new york and oregon, to be able to deliver an ultimatum to their insurance company. that ultimatum should be treat me right or i am taking my business elsewhere.

just that simple. that's the way we do it in every other part of american life. and by the way, madam president, that's the way it works for all of us here in the united states senate. we belong to a real marketplace. we belong to a real exchange. if a member of the united states senate doesn't like their health care coverage in november of 2009, come january of 2010, that member of the united states senate can take their business elsewhere, can take their business to another insurer who does a better job for them. i think that kind of marketplace, the marketplace that every member of the united states senate now enjoys ought to be available to everybody else in the country, and i think there ought to be public choices, i think there ought to be private choices, and, madam president, i think all americans

ought to be able to get all those choices. and we're not going to be able to have real insurance company accountability. real choice and real competition unless we get the exchanges bigger and get more people in. and to illustrate the fact that the majority leader and other leaders, chairman baucus are open to new ideas, let me say that just yesterday the majority leader and chairman baucus and i agreed on an approach that will allow more people to enjoy the marketplace, the fruits of a specific system more quickly when they indicated yesterday that they would support my legislation to expand access to the exchanges for those who otherwise would have no health insurance at all. let me emphasize that, madam.

letting folks get to the exchanges, folks who otherwise would have no health insurance at all. and we have been able to do it. according to the congressional budget office, been able to add an additional million people, million people, middle-class folks walking on an economic tightrope at less than half of the cost, madam president, of what it would cost to have those people get their coverage through medicaid or a subsidized system. and it is my intent to work with the majority leader closely and chairman baucus to allow others to have a chance to be part of this kind of competitive system, and i commend the majority leader and chairman baucus for their commitment to work with me as this bill goes to the floor to expand access to these

marketplaces. madam president, let me close with one as are point. -- with one last point. i see my colleague is on the floor as well, a welcome addition to the united states senate. a lot of americans listening in my wonder why the united states senate is turning its attention to health care when there is so much economic hurt in our land. madam president and colleagues, the fact of the matter is fixing the economy and fixing american health care are literally two sides of the same coin, and we have got to rein in these costs. we have got to rein in these costs for americans to have more take-home pay, be in a position to pay for essentials and to allow our workers to compete in ferociously challenging markets around the world. it is time to move beyond the town hall brawls of this past summer. for the senate, as i indicated

i'm going to try to do to work with senator reid, work with all colleagues to break through and deal with this critical issue. the premier long-term challenge of our times for our economy, madam president, do it in a bipartisan way. i urge my colleagues to vote for the motion to proceed, and i yield the floor. mr. udall: madam president, i seek recognition. the presiding officer: ?oom new mexico. mr. udall: thank you very much. i enjoy listening to senator wyden and his comments on health care reform. i think he has been one of the leaders when it comes to working in the finance committee and looking for significant reforms on health care and look forward to working with him in that capacity. the health care reform we're debating today will impact every person in this country. whether you're searching for affordable insurance for yourself or watching helplessly as a loved one is denied

coverage. every american stands to gain something through this historic legislation. in my home state of new mexico, the people i represent don't just have a lot to gain from this reform. they also have a lot to lose if this reform is not enacted. for new mexicans, the status quo isn't an option. that's because without this health care reform, our state is expected to experience the largest increase in insurance premiums of any state in the union. in 2016, without this reform, a family of four in new mexico can expect to pay an astounding astounding $28,000 a year in health care premiums. that will consume more than 56% of that family's projected income for the year. affordability is already one of the key barriers to obtaining

coverage in my state. since 2000, premiums for residents have risen 110%. as a result, almost one in four people don't have insurance. giving us the second highest uninsured rate in the nation. enactment of this reform legislation would make as many as 249,000 middle-class new mexico residents eligible for premium credits to ease the burden of these high costs. in addition, almost 238,000 new mexicans would be eligible for new private coverage through the exchange or through their employers. and another 124,000 would be eligible for the new expanded medicaid coverage. and for the families that already have insurance, they win, too. they will likely see lower premiums, thanks to the increased competition in the

market. the bottom line is that with this reform, the vast majority of new mexicans would have access to quality, affordable health care for themselves and their families. but reform will also benefit new mexico's small businesses. in 2006, less than 35% of small businesses in my state offered coverage for their employees. that figure means our state ranks dead last in employer-sponsored insurance in the nation, a dubious distinction to say the least. i've talked to a lot of these small business owners over the past months, and they all tell me pretty much the same thing: i would love to offer coverage to my employees, but it's just too expensive. they say they're having a hard time affording insurance for their own families. to those small business owners, i say help is on the way. the patient protection and

affordable care act will help you provide insurance to your employees by providing federal tax credits of up to 50% of premiums should you choose to offer coverage. in addition to lowering costs for individuals and families and helping small businesses, this reform would also give our rural communities additional tools to provide quality, affordable health care for all of their residents. of the two million people who call new mexico home, about 700,000 live in rural areas. they are more likely to be uninsured and often must travel hundreds of miles for preventative or emergency care, if they're able to find any care at all. in this bill, we have included pay incentives to recruit more physicians, madam president, more physicians to be recruited to serve in these underserved

rural areas. we will improve dental services in rural areas. we will extend medicare payments for ambulances in rural areas, and we will expand the tele help programs so that rural residents may receive specialized treatment not available in their local areas. finally, we have made sure that this legislation won't result in an funded -- in an unfunded mandate for our federal government which is already experiencing the pain of budget cuts thanks to the economic downturn. this legislation would require the federal government to cover 1 of the costs of the -- to cover 100% of the costs of the medicaid expansion from 2014-2016, and 95% of that cost after that. when it comes to health care today, too many new mexicans are living on a cliff, teetering on the edge of financial ruin. all it would take is an illness

or a job loss and they could fall into the abyss of medical invoices, bill collectors and bankruptcy. for these new mexicans, the status quo isn't an option. this bill offers a life rope to these new mexicans to pull them back from the precipice. passing it would provide stability and security to those who have insurance, affordable coverage to those who don't, and lower costs for families, businesses, and government. so this is a historic moment, madam president. i urge my colleagues to join me in seizing it. so let's begin the debate on this long overdue legislation to reform our broken health care system. and with that, madam president, i yield the floor. a senator: madam president? the presiding officer: the senator from hall of fame. mr. gregg: i understand the next hour is allocated to the republican side? the presiding officer: that is correct. mr. gregg: i would ask unanimous consent we be allowed to

participate in a colloquy on our side as it evolves here during that hour. the presiding officer: without objection, so ordered. mr. gregg: madam president, what we're going to do -- i know we are joined by some of the most distinguished members of our caucus. they have some thoughts they want to express. then we want to discuss a couple of points in this bill. before i turn to the senator from missouri, i just want to make a point because i have been listening to a lot of the discussion here on the floor and i have obviously participated and listened to a lot of it on television. my colleagues on the other side of the aisle. they continue to use this number. they claim this bill costs costs $800 billion and some dollars. that's the number that has been reached as the expenditure on this bill. ladies and gentlemen, that is a totally dishonest number. that is the ultimate shell game. that is washington cynical politics. you know how they get to that number? this is a ten-year number, by the way. how they get to this number of

of $890 billion as the cost of this bill, which by the way that's a lot of money, money, $800 billion. that would run the state of new hampshire for, i don't know, probably 100 years. almost literally 100 years. i don't know how long it would run missouri, a little bigger state, but a while. probably run alabama for a little while, too. south dakota could run for 200 years, for all i know. it's a lot of money, $800 billion-plus. but that is not the cost of this bill. that is not the cost of this bill. the way that number was arrived at -- and i think the american people need to understand, because if that number was so honestly arrived at and -- what does the rest of the american people not know about. the way that number was arrived at was that they don't start spending money on this bill until the fourth or the fifth year. they couldn't get the score they

wanted. they couldn't get the score they wanted from c.b.o., so they changed the year. they moved back another year in the ten-year cycle. they went from four years to five years as to the starting point of most of the spending in this bill. what they claim to the american people is that a ten-year bill is going to cost about $800-plus billion. what they don't tell the american people is they're not spending anything in the first four or five years of the bill. no. they do raise your taxes throughout the ten-year period. they do cut medicare throughout the ten-year period. but they don't spend the money. they don't start the programs until the year 2014, when this bill is fully phased in, when all these new programs, these massive expansion of entitlements are created, these brand-new entitlements. when all this new spending occurs, this bill will cost $2.5 trillion over that ten-year period.

$2.5 trillion. that's the real cost of this bill. that's how big this government is going to grow in a ten-year window as a result of this spending. well, ladies and gentlemen, i think most of us understand that we already have a huge debt problem in this nation, that we're passing on to our kids a country with so much debt that they're not going to be able to afford it. every year for the next ten years, without this health care bill, the president has proposed budgets which will run $1 trillion deficit. every year on average for the next ten years. sometime this month we're going to have to raise the debt ceiling of this country because we've reached $12 trillion in debt. and then it's going to have to be raised again because we're running up these massive deficits. the debt owed by this country will exceed 80% of our gross domestic product. 80% of our gross national

product at the end of that ten-year period and exceed 60% of our gross national product within two years. those are unsustainable numbers. yet, we're proposing a bill here on the floor, a bill is being proposed here on the floor that is going to expand the size of government by $2.5 trillion. it is alleged it's paid for. we're going to get into discussion of that in some depth because i think that is an equally cynical number of bait and switch. i just wanted to clear the air as to the real cost of this bill because i found it uniquely cynical that it would be represented that this bill costs $890 billion, or whatever the number was. and it does call into issue the credibility of the rest of the numbers that are being thrown out by the other side of the aisle when they use that number, which is a five-year number that they claim covers a ten-year cost when they don't do anything in the first five years of that. i appreciate the indulgence of the senator from missouri. i understand he wishes to speak.

then we'll go to the senator from alabama, and then the senator from south dakota, and then we'll have a little discussion here about some of these issues, like cost, like how it affects medicare, thousand affects small businesses, how it's going to affect your personal insurance. mr. bond: madam president, i thank the senator from new hampshire. i want to clarify some things that he has said because they are truly important. i want to make sure everybody understands because senator gregg and his position on the budget committee, as well as his other positions in writing this bill is intimately acquainted with the costs of this. now, the cost for 2010 to 2019, how much is the cost for that ten-year period? mr. gregg: $1.2 trillion. because between the period 2010 and 2014, there are no expenditures because they don't start the programs until 2014.

mr. bond: is this the total expenditures or are these just the expenditures that are not covered by -- after 2014, that are not covered by the so-called tax or revenue raisers? in other words, is this, does this all go on to the debt or is this -- mr. gregg: no. those are total expenditures represented to be offset by cuts in medicare, increased fees and increased taxes. mr. bond: how much are the cuts in medicare? mr. gregg: when it is fully phased in, in the ten-year period 2014 to 2023, the medicare cuts are $1.1 trillion. mr. bond: $1.1 trillion cuts in medicare. and how much are the taxes and the other, quote, revenue raisers in that period? mr. gregg: the taxes fees

during that period, this period, when it's fully phased in, are approximately $1.5 trillion. mr. bond: okay. so how much will -- how much will go on to the debt? how much is uncovered? mr. gregg: actually, if you accept these assumptions that we are going to cut medicare by $1 trillion and take that to create a new entitlement instead of using it to help medicare be more solvent, and that we're going to raise taxes and fees by $1 trillion -- remember, most of this is not going to come out of the wealthy. it's going to come out of small businesses and higher premium costs to people on medicare, on insurance. or it's going to come out of h.i. taxes. if you accept that logic, which i find to be a bit of a reach, then it won't have any impact on the deficit in that time frame because they cut medicare to pay for it, and they've raised all these taxes to pay for it. mr. bond: my friend has been very active in the budget

committee. how many times have we cut medicare, have we allowed medicare cuts to go into effect? how many times? i think that's a rather rare occurrence isn't it? mr. gregg: i was chairman of the budget committee the last time we tried to do something in the rate of growth of the medicare costs because we received a directive from the medicare trustees that medicare had to be made more effective or it would go embryonic. so we suggested when i was -- or it would go broke. we suggested we should reduce the rate of growth of medicare by $10 trillion on a $1 trillion time frame. medicare was going to spend $1 trillion over a period, five years. we are going to suggest a raeuft reduction which was going to be paid for by requiring people who had part-d premiums and high incomes to pay for part of their premium. people like warren buffet would no longer be subsidized by people who work at the restaurant.

we didn't get one vote for that. we passed it by having the vice president come sit in the chair and vote to break the tie. that was $10 billion over five years. i think this idea that you're going to do $1 trillion over ten years and pay for this, well, first off, if you're going to reduce medicare spending or raise medicare taxes, it should go to pay for medicare solvency because medicare is insolvent. it shouldn't go to create a new entitlement. senior citizens who have been paying into medicare all their life shouldn't have their money taken to start a brand-new entitlement for other people. and that's what this bill does. but as a practical matter, that's -- we're not going to do that. we know that. we know this is all going on the debt. 90% of this is going to end up on the debt, i think. mr. bond: i thank my colleague from new hampshire because he has been a very solid, consistent, credible voice. and what he is pointing out today, madam president, is that the legislation we're debating

has major implications for every american family, every american taxpayer, every american small business. in 1992 election, president clinton's famous slogan was "it's the economy, stupid." 17 years later it is again the economy that's a major issue facing the people. but this time the majority party does not seem to be paying attention. instead, the majority has used its supermajority position to spend trillions of dollars that we don't have, including a misnamed stimulus that stimulated the growth of the deficit and the federal government but not jobs, and takeovers and bailouts of banks, insurance companies and major auto manufacturers. they have adopted a budget that would double the debt, the debt our grandchildren owe in five years and triple it in ten. it's little wonder, it's little wonder that the unemployment

rate has skyrocketed because employers are afraid to hire. families are seeing their budget strapped like never before. but the bill before us is a kroepbg achievement of the drive -- is a skroupbing achievement -- is a crowning achievement of the drive to destroy our economy. one year, instead of debating how to create jobs we're debating a bill that will most likely kill jobs. don't get me wrong, our health care system is in need of reform. some of the biggest problems in health care, it costs too much, too many junk lawsuits, not enough focus on prevention and wellness. while we all agree that reform is necessary, the american people expect us to answer the questions, how much will reform cost and can we afford it? will it lower health care costs? can you keep your current plan?

what role will the government play? the answer to two and three in this bill is no it won't lower our health care costs. no, you won't be able to keep your current plan. then the question is who will make health care decisions? well, we're seeing evidence that they have government committees that say when you can get a mammogram, when you should get pap screening. will americans and members of congress have time to evaluate what's in the legislation? well, we hope today and yesterday that we will bring out for the american people the cost of this. because what we're seeing in this massive pot, 2,047 pages, is that there are lack of commonsense reform. it's filled with costly budget gimmicks. and asks the people of america to spend over $2 trillion on proposals that will heap a

mountain of debt on our children and grandchildren. $2 trillion is an almost unfathomable amount of money, but in washington trillion is the new billion. and that's not the kind of health care reform americans want. it's not reform at all. it spends too much. it taxes too much. and it cuts medicare too much. and it doesn't provide the reforms we need. nearly $500 billion in taxes will be added to the backs of the american people. $28 billion in taxes on businesses which will kill jobs at a time when we have over 10% unemployment and even higher if you include the number of people who are no longer working or are underemployed. and the higher costs will ultimately be passed on to american workers and consumers. anybody who thinks that you're going to tax health care insurers or device providers and expect that those costs will not be passed on to the consumers,

that's you and me, madam president, the head of the congressional budget office, the joint committee on taxation has said these higher taxes are passed along, and they will land on families, small businesses, on individuals. it will also force americans into government run health care plan. it will ration care and limit access to lifesaving treatments. in life, two things you can count on, they were said to be death and taxes. i didn't expect to see them both in a health care reform proposal. we call this a pig in a poke. the only way to sell a pig in a poke is to hide from americans what their tax dollars are really buying. if i were to outline all the problems in this 2,000-page bill, we'd be here until thanksgiving. it's sort of like, we're like a mosquito in a nudist colony. there are so many targets to attack in this bill, we don't know which one to hit.

but let me give you just a few things. as the senator from new hampshire pointed out, the real cost of this bill to the american people is a whole lot more than they admit. the majority is claiming that the bill only costs $850 billion, but the way the majority gets to say that is because they're pulling a great smoke and mirrors trick. even more incredible is the democrats claim their bill will cut the deficit. it's a great scheme, but no one outside of washington actually believes this health care bill will do anything but increase costs and pile more debt on our kids and grandkids. and they're right. right now, as the ranking member of the budget committee has pointed out, the national debt already exceeds $12 trillion, and this bill will put more on that. now the true cost of the bill isn't just a he said, she said.

even the nonpartisan congressional budget office acknowledges that the majority's bill includes gimmicks that hide the true cost of the bill. part of the majority scheme, to hide from americans the true cost, is the great stunt as the senator from new hampshire has described, to push back implementation of parts of the reform to 2014 but start collecting money in taxes now. that means tax now and pay later. that sure makes your numbers look good, doesn't it? for example, medicaid expansion doesn't begin until 2014. that's in section 2001. section 1311 says health insurance exchanges are not fully operational until january of 2014. section 1323 says public health insurance option is not available until 2014. most of the major insurance

reforms, however, in section 1253 take effect in 2014. yet, the tax on health insurance starts in 2010. that's section 9010. section 9009 says the tax on medical devices starts in 2010. section 9008 says the tax on manufacture pharmaceuticals states in 2010. that's even worse than that which initially had it starting in 2013 but it is a great gimmick to allow them to hide the cost of the bill. by recording taxes over ten years and only scoring costs over six years would get an officer in a publicly traded corporation sent to jail. move over, bernie madoff. tip your hat to a trillion-dollar scam. this is magnificent, and that's in this bill. i'm glad that all americans can read it. they can check out the sections

that i cited. even the congressional budget office has called bull on this stunt, saying it would be difficult to maintain the predicted savings the majority has been touting. no wonder. and the true costs, as the senator from new hampshire has pointed out, is $2.5 trillion. in fact, but it will also be increasing taxes. and, in fact, everyone will be taxed one way or another. forget what the president promised about no taxes. sections 9004 and 9010 will tax americans who have insurance. section 1501 will tax americans who don't have insurance almost $8 billion. taxes will be placed on medical device manufacturers and 9009, and as the c.b.o. has said, those taxes will be passed on in the form of higher prices and, thus, in the -- in the form of

higher insurance premiums. because of the tax on health insurers, section 9010, the c.b.o. and the joint committee has said these taxes will be passed on in the form of higher health care premiums. price waterhouse coopers says that's $487 a year per family. that's how much these taxes on the health insurers and health payment plans will cost the average family. now, employers will be taxed about $28 billion in new taxes will be placed on employs that don't -- on employers that don't meet government-approved health care plans. that's section 1513. and that's where american workers are going to pay for it, because that's where they lose their jobs. headlines in the "wall street journal," letters i've seen from leaders of businesses saying, we're not expanding. we can't afford to expand. we're not -- we can't afford to take on more employees. why are we having a jobless recovery? because of the threats of

washington over spending, over controlling, over taxing and over -- overspending, overcontrolling, overtaxing, and overspending and overregulating are telling employers that you are about to hitch the ditch with all the things that government's putting on you. now, yet for all the taxes and mandates, according to c.b.o., about 5 million americans would lose their -- their employer coverage. that's because the costs would go up, the regulations would go up. 83% of americans have health insurance and they're concerned that it costs too much. americans want affordable health care, but this bill raises the cost of health care. new taxes and mandates will be passed on to american families, american taxpayers, and american small businesses. the bill still leaves 24 million americans without insurance. according to the c.b.o., the government-run plan will have

higher premiums, and the c.b.o. said it will drive the cost of health care up. this was supposed to lower the cost of health care. it won't do anything of the kind. to sum up, $2 trillion in more spending gets -- in the 2,074 pages, the federal bureaucracy, increases the cost of health care, raises premiums, slashes medicare for seniors, and puts unfunded burdens on states. and let me just make two last points. the states, according to c.b.o., will get coverage for these new medicaid eligibles for two years that they will get covered, and then they'll dump it on the states. $25 billion. $25 billion cost. the senator from new hampshire and i were both governors of our states, and i can tell you, the states don't need that kind of burden, particularly in a

difficult circumstances there are. and slashing medicare -- slashing medicare for seniors, in missouri, already medicare only pays 8 0% of the costs. -- 80% of the costs. more and more doctors and hospitals have to limit the number of medicare patients they can accept. if we continue and if they push through this medicare cut, then fewer and fewer medicare patients are going to be able to get health care. madam president, i hope my colleagues will listen to what the american people are telling us and vote against the bill. that's certainly the message i'm getting from missouri. and i yield the floor. mr. sessions: madam president? the presiding officer: the senator from alabama. mr. sessions: i thank senator bond -- i think senator bond has certainly delineated some of the fiscal impossibilities in this

bill, as has our former budget chairman and now ranking member of the budget committee, judd gregg, has delineated. he's studied this very, very hard. the information he provided to this congress and to the american people is accurate. i've tried to think what i should say about this bill this morning and be realistic and honest and boil it down to its essence, that 2,000 pages that sits on its desk there, how should we talk about it. well, let me just say, the claim is from our colleagues that they have a great plan to reform health care and it will fix the problems in health care. and we do have problems in health care that need to be fixed. they're going to provide methods and additional funding and -- and provide millions of people

with insurance that didn't have it before, although 24 million will remain uninsured, and at the same time save $130 billion over ten years and we're supposed to be grateful and say how pleased we are that you've been able to pull off this event. but the first reaction most american people have had -- and it's a sound one is -- wait a minute, that's pretty dubious. how can do you that? do you remember that song from the "souped of music," "nothing coming from nothing; nothing ever could" said julie andrews. so the result really is is -- a phrase i studied, i came up with, that is really is a shell game, senator gregg. i think that's exactly what we're talking about. when it became obvious to everybody who could add that this great vision, this wild can

khaimiera that they would not work as they dreamed it, the mount banks began their which i canary. my remarks -- in my remarks, i will not attempt to point out all of the problems in this bill, just some of the more obvious that are inescapable. first, you ask, why do they do this? the answer is the numbers don't add up. they can't make the numbers do what they want them to do. and so they've either got to be honest and talk about massive cuts openly or massive tax increases. the american people are want too sure about that, to add a whole new monumental health care program at a time of colossal problems in this country, the likes of which this country has never, ever seen before. that we're now going to start off on a monumental,

multitrillion-dollar bill that won't be paid forrivity. so you've got this -- that won't be paid for itself. so you've got this great promise and it's not adding up. do you slow down? do you begin it to think, well, if we can't do everything we promised in the campaign and we love to do and we wanted to do, what progress can we make step by step do we make in this time when we can't afford unemployment and unprecedented deficits? no, that's not what they decided to do. what they decided to do was go forward anyway and call anyone that has the temerity to say the emperorrer has no clothes that these are dr. no -- you're against everything, you don't believe in any reform. you know? that's kind of the idea that we're hearing here and that's not correct. so the bill is just too much, goes too far too fast and costs too much. we don't have the money. the american people know this.

that's why they oppose this bill. they're not opposed to reform and progress. they are opposed to this legislation, this two-foot-thick, three-foot-thick, 2,000-page piece of legislation. and they don't dislike president obama but they don't like this policy he's trying to promote. so you say, well, let's have some facts about it. i can't explain everything but i will share a few things. a critical -- and, madam president, i would ask to be recognized -- to be notified after five minutes. the presiding officer: without objection. mr. sessions: a critical, essential part of fixing a broken health care system is to end the growing problem of payments to our doctors.

republicans and democrats hav have -- have not been good on this issue in the past together, but the problem grows worse each year. essentially in the balanced budget act of 1997, we limited the amount of payments to doctors. after awhile, it became clear that the payments were too severe. and each year we've put money back in. but the law still mandates major cuts. in fact, today, if we don't do what we call "the doctor fix" each year, they will have a 23% reduction in reimbursements. and they get paid less from -- this is from medicare. and they get paid less from medicare than other insurance already, and so doctors are going to quit doing it if you have a 23% reduction in what they have to pay -- they get paid for doing their work. so how much does it cost to permanently fix that, as the

medical profession assumed we were going to do and as the president and his team have indicated they planned to do? it costs $250 billion. that's a lot of money. that's not a new program. this is an obligation that we have now. so does this plan fix that? it fixes it for one year. so it goes out one year and then the c.b.o. score assumes that the doctors' payments will drop 23% and be 23% lower for nine years. you add that up, that's $250 billion. now, and it allows the folks in the know here to manipulate the numbers and hide a $250 billion debt. that we owe. you can't -- we just can't cut doctors that much and we're not going to do it. we haven't been doing it and we'll fix it every year, in

fact, and that's how -- what i would say is we will spend the $250 billion. and it should be in this bill. didn't do it. just a few weeks ago when they met in this secret room down here in the hall and they got to talking and they were saying, what are we going to do about the doctors? how are we going to fix the doctors? well, we could raise taxes -- oh, we've raised taxes $500 billion. we can't raise them any more. can we cut medicare? gosh, we've cut it $500 billion. we can't do that. so what can we do? we promised to fix the doctors fix and get them their pay, so they offered -- it would be hilarious, really, if it wasn't so serious -- they offered legislation a few weeks ago to just pay the doctors permanently all this money outside of the health care reform, in a separate bill, every penny of it going to the debt, unpaid for.